Post-Tib Tendonitis: Orthopedic Treatment

A tendon is a soft tissue structure that connects the muscles to the bones. The posterior tibial tendon is found on the inner side of the foot near the ankle and it connects the calf muscle to the ankle. It is a an important tendon in the leg as it supports the foot while walking and hold up the foot arch. Stress caused to this particular tendon is known as the Post-Tib Tendonitis. Stress may be in the form of inflammation or tearing of this tendon. It may result in loss of foot stability and collapse of the foot arch.

Causes

  • Presence of over-pronation feet causes damage to the posterior tibial tendon
  • Overuse of the muscles in the feet leads to damage of the tendon resulting in this condition
  • A fall on the foot that may cause severe injury
  • Playing high impact sports such as basketball, tennis may tear or stretch the tendon

Symptoms

  • Development of over pronated feet as the tendon cannot support the foot arch
  • Pain
  • Growth or heel spurs
  • Pain is aggravated while walking, running, weight bearing
  • Pain and swelling may occur periodically in the initial stages but becomes permanent as the condition aggravates
  • The heel bone may shift to a new position as the foot arch collapses and cause change in shape of the foot
  • The foot is visibly deformed with a tilted heel and inward bent foot
  • If the foot of the patient is observed from behind in a standing position, many toes are visible which indicates over pronation
  • The calf muscles may be tight

Diagnosis

  • The details of the patient’s medical history, symptoms and mode of injury may be taken into account
  • The foot may be moved, palpated and observed for visible signs of the condition, loss of flexibility and other symptoms
  • Single limb heel test - The patient may be asked to stand on one leg and raise the heel. Inability to do so indicates tendonitis
  • Range of motion of the foot
  • X-ray imaging may be required
  • MRI, CT scan and ultrasound tests may be needed

Treatment

  • Rest your feet adequately and avoid weight bearing as well as any physical activity that causes pain for a few days
  • Shoe inserts and orthotic devices can be used to provide better protection, shock absorption and reduce the stress on the post tibial tendon or the plantar fascia
  • The exercise should be varied so that the same part and muscles of the foot is not strained every time
  • Ice packs can be applied 4-5 times a day to reduce swelling
  • Pain killers and anti-inflammatory medicines may be prescribed
  • The leg may be immobilized in a cast or a boot for 6-8 weeks
  • An ankle brace to correct the flat foot deformity
  • Steroids may be injected into the affected joint
  • Physical therapy may be helpful
  • Surgical lengthening of the calf muscles
  • Surgical removal of the damaged tendon
  • Surgical repair of the torn tendon
  • Arthrodesis or surgical fusion of the joints may be done to treat Flat Foot and Arthritis

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